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Domestic Medical SCHOOL Education
Robert James Cimasi
Todd A. Zigrang
U.S. medical education began in the late eighteenth century as an apprenticeship program in which physicians taught their trade to a few pupils, a pedagogical learning style which relied heavily upon the capacity, skills, and knowledge of the individual physician.[1] However, as learning newly discovered information and utilizing new technologies became more necessary to the industry’s practice, many physicians found the apprenticeship system no longer adequate as a manner of educating the next generation of physicians.[2] As a result, the conventional concept of medical education that originated in the U.S. in the 1750s was manifested through informal courses and demonstrations by private individuals or for-profit institutions. Those individuals who were not satisfied with a typical U.S. medical education, consisting of two identical 16-week lecture terms, might venture to Europe for a more formalized and detailed manner of learning.[3]
One of these students who studied in Europe was William Shippen, who began teaching an informal course on midwifery when he returned to the American colonies in 1762.[4] He later addressed the limitations of what might be taught in one informal course when he began teaching a lecture series on anatomy to help educate those who wished to be a physician, but could not travel abroad. John Morgan, a classmate of Shippen, noticed the potential of his friend’s endeavor and proposed the idea to create a professorship for the practice of medicine to the board of trustees of the College of Philadelphia.[5] Just across town, Thomas Bond, who conceived the idea of, and successfully established, the Pennsylvania Hospital with Benjamin Franklin, recognized the value to allowing medical students to participate in bedside training.[6] When Bond agreed to a partnership with the College of Philadelphia, the University of Pennsylvania became home to America’s first medical school.[7]
In 1893, Johns Hopkins University also made history by housing the first medical school that was able to operate out of a university-owned hospital.[8] The medical school not only encouraged clinical research to be performed by every member of their faculty, but the program also included a clinical research clerkship for every student during their rotation.[9] This program quickly became the model to which schools aspired and set the foundation for national medical education by connecting science and medical research with clinical medicine.[10]
With these early examples of medical schools, America’s field of medical education and clinical medicine made monumental strides. However, the societal pressures, caused by the U.S.’s population growth and demand for educated physicians,[11] did not allow many other universities to build on Johns Hopkins’ or the University of Pennsylvania’s foundation model, and led to the development of medical schools that had their own unique set of entrance and graduation requirements. While some focused entirely on medicine, other schools (termed Studia Generalia) also incorporated law, theology, and philosophy in their curricula.[12] In an attempt to both understand and make uniform the field of medical education, the American Medical Association (AMA) founded the Council on Medical Education (CME) in 1904.[13] The CME created minimum national educational standards for training physicians, and subsequently found that many schools did not meet these established standards.[14] However, the CME did not share the ratings of any of these medical schools “outside the medical fraternity.”[15]
In 1910, the AMA commissioned the Carnegie Foundation for Advancement of Teaching to conduct a study of medical education and schools.[16] Abraham Flexner conducted the inquiry and detailed his findings in what became known as The Flexner Report.[17] In his review of the U.S. medical education system, Flexner found that many of the proprietary medical schools met the AMA’s educational goals, but an imbalance existed between the pursuit of science and medical education.[18] Professors were focused solely on student throughput, and did not ensure a high level of medical training that reflected the developments in the medical industry.[19] As aptly noted by Dr. John Roberts in his book entitled The Doctor’s Duty to the State, “[m]any of you remember the struggle to wrest from medical teachers the power to create medical practitioners with almost no real knowledge of medicine. The medical schools of that day were, in many instances, conducted merely as money-makers for the professors.”[20] As the AMA gained more influence over the provision of healthcare in the U.S., the value and power of medical education also gained recognition. Notably, teaching hospitals had the power to influence the development of their disciplines through their research initiatives, the quality of care they provided, and their ability to operate as an economy of scale, allowing them to dictate the evolution of medical education.[21]
Since the establishment of the first medical school in the U.S., medical education has been the foundation for shaping standards of care in the practice of medicine and defining medical errors as deviations from the norms of clinical care.[22] When Thomas Bond helped establish the University of Pennsylvania medical school, he envisioned a normal day where the physician:
“…meets his pupils at stated times in the Hospital, and when a case presents adapted to his purpose, he asks all those Questions which lead to a certain knowledge of the Disease and parts affected; and if the Disease baffles the power of Art and the Patient falls a Sacrifice to it, he then brings his Knowledge to the Test, and fixes Honour [sic] or discredit on his Reputation by exposing all the Morbid parts to View, and Demonstrates by what means it produced Death, and if perchance he finds something unexpected, which Betrays an Error in Judgement [sic], he like a great and good man immediately acknowledges the mistake, and, for the benefit of survivors, points out other methods by which it might have been more happily treated.”[23]
Originally, students were to study and learn from medical errors and adverse events through medical education as a means of improving the quality of care. However, it is difficult to effectively implement any significant advancement learned through the research and investigation of prior errors in a timely and cost-effective manner. Additionally, physician supply shortages have only increased the amount of patients that a physician must see daily, while simultaneously decreasing the amount of time they can spend with each patient. Although medical education continues to be one of the central underpinnings to the development of the medical industry, outside pressures that shape the clinical practice of physicians continue to limit physician effectiveness in providing quality care to patients.[24]
While improving the quality and rigor of medical education has been a constant focus throughout the history of U.S. medical education, the challenges of replicating it on a scale that produces enough qualified physicians to meet the growing demands of the U.S. population, with constantly changing technologies, has consistently been a central issue. Notably, in the 13 years preceding 1980, the ratio of actively practicing physicians to patients increased by 50%.[25] This increased physician-to-patient ratio led to concerns over quality of care and cost-effectiveness, which in turn caused the creation of a government committee to evaluate physician manpower allocation and distribution. The Graduate Medical Education National Advisory Committee (GMENAC) was first chartered in April 1976, and later extended through September 1980.[26] Its purpose was to “analyze the distribution among specialties of physicians and medical students and to evaluate alternative approaches to ensure an appropriate balance,”as well as to“encourage bodies controlling the number, types, and geographic location of graduate training positions to provide leadership in achieving the recommended balance.”[27] GMENAC produced seven volumes of recommendations regarding physician manpower supply,[28] through the development of several models by which to determine the projected number of physicians that would be needed in the future by different subspecialties to achieve “a better balance of physicians.”[29] Ignoring critics of the report, U.S. medical schools adjusted their enrollment numbers in response to the GMENAC’s recommendations, causing a significant decrease in the supply of new physicians going into the 21st century.
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[1] “Healthcare Valuation: The Four Pillars of Healthcare Value,” Volume 1, Robert James Cimasi, MHA, ASA, FRRICS, MCBA, CVA, CM&AA, John Wiley & Sons, Hoboken, NJ: 2014, p. 22-23.RR
[2] “Before There Was Flexner,” American Medical Student Association, 2014,
http://www.amsa.org/AMSA/Homepage/MemberCenter/Premeds/edRx/Before.aspx (Accessed 1/7/15).
[3] “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:
Oxford University Press, 1999, p. 4.
[4] “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health
Publications, Inc., p. 3-5.
[5] “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health
Publications, Inc., p. 3-5.
[6] “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health
Publications, Inc., p. 3-5.
[7] “Before There Was Flexner,” American Medical Student Association, 2014,
http://www.amsa.org/AMSA/Homepage/MemberCenter/Premeds/edRx/Before.aspx (Accessed 1/7/15).
[8] “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:
Oxford University Press, 1999, p. 18-19.
[9] “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:
Oxford University Press, 1999, p. 18-19.
[10] “Science and Social Work: A Critical Appraisal,” By Stuart A. Kirk, and William James Reid, New York, NY: Columbia University Press, 2002, Chapter 1, p. 2-3.
[11] “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health
Publications, Inc., p. 6-7.
[12] “Western Medicine: An Illustrated History,” By Irvine Loudon, New York, NY: Oxford University Press, 1997, p. 58.
[13] “Western Medicine: An Illustrated History,” By Irvine Loudon, New York, NY: Oxford University Press, 1997, p. 58.
[14] “Western Medicine: An Illustrated History,” By Irvine Loudon, New York, NY: Oxford University Press, 1997, p. 58.
[15] “Western Medicine: An Illustrated History,” By Irvine Loudon, New York, NY: Oxford University Press, 1997, p. 58.
[16] “U.S. Health Policy and Politics: A Documentary History,” By Kevin Hillstrom, Thousand Oaks, CA: CQ Press, 2012, p. 141.
[17] “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health
Publications, Inc., p. 3-19.
[18] “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health
Publications, Inc., p. 3-19.
[19] “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health
Publications, Inc., p. 3-19.
[20] “The Doctor’s Duty to the State: Essays on The Public Relations of Physicians,” By John B. Roberts, AM, MD, Chicago, IL: American Medical Association Press, 1908, p. 23.
[21] “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:
Oxford University Press, 1999, p. 19.
[22] “Science and Social Work: A Critical Appraisal,” By Stuart A. Kirk, and William James Reid, New York: Columbia University Press, 2002, Chapter 1, p. 2-3.
[23] “Dr. Thomas Bond’s Essay on the Utility of Clinical Lectures,” By Carl Bridenbaugh, Journal of the History of Medicine (Winter 1947), p. 14; “The Flexner Report on Medical Education in the United States and Canada in 1910,” By Abraham Flexner, Bethesda, MD: Science and Health
Publications, Inc., p. 4.
[24] “Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care,” By Kenneth M. Ludmerer, New York, NY:
Oxford University Press, 1999, p. xxi.
[25] “How many doctors are enough?” By J.E. Harris, Health Affairs, Vol. 5, No. 4 (1986), p.74.
[26] “Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services – Volume VII,” Graduate Medical Education National Advisory Committee, Washington, DC: U.S. Government Printing Office, 1981, p. 5, 16.
[27] “Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services – Volume VII,” Graduate Medical Education National Advisory Committee, Washington, DC: U.S. Government Printing Office, 1981, p. 73.
[28] “Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services – Volume VII,” Graduate Medical Education National Advisory Committee, Washington, DC: U.S. Government Printing Office, 1981, p. 5-6.
[29] “GMENAC: Its Manpower Forecasting Framework,” By D.R. McNutt, American Journal of Public Health, Vol. 71, No. 10 (October 1981), p. 1119.
[30] “Crossing the Quality Chasm: A New Health System for the 21st Century,” Institute of Medicine, National Academy of Sciences, 2001, front matter.
[31] “Overview of Medical Errors and Adverse Events,” By Maité Garrouste-Orgeas, et al., Annals of Intensive Care, Vol. 2, No. 2 (2012), p. 6.
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Low-income communities often struggle to access healthcare services, but a new analysis of federally qualified health centers (FQHCs)—which provide quality care to patients regardless of ability to pay—has helped nail down one reason. When it comes to screening for certain cancers, these nonprofit community health centers have fallen far behind the national average, according to a study led by cancer center researchers at the University of Texas MD Anderson and the University of New Mexico.
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Healthcare bankruptcies surged in 2023, and it turns out many of the companies that went under had one thing in common: private equity (PE) ownership. At least 21% of the 80 healthcare companies that filed for bankruptcy last year were PE-owned, according to a report from the nonprofit Private Equity Stakeholder Project (PESP).
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Warren Buffett on contemplated his own mortality at Berkshire’s meeting. Succession was the topic du jour at the Berkshire Hathaway shareholder meeting in Omaha last week. After his longtime business partner Charlie Munger died last year at 99, CEO Warren Buffett—who turns 94 in August—revealed his heir apparent, Greg Abel, will have the final say on investment decisions in his absence. Buffett ended his Q&A portion with the quip, “I not only hope you come next year. I hope I come next year.” Adding to the ominous vibes, Buffett said AI is a genie that “scares the hell out of me.”
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Here’s where the major benchmarks ended:
Semiconductors were among the strongest performers Monday behind Micron Technology (MU), whose shares rallied 4.7% after Robert W. Baird upgraded the chipmaker to “outperform” from “neutral.” Micron Technology was the top gainer in the Philadelphia Semiconductor Index (SOX), which advanced 2.2% to near a four-week high.
Small-cap stocks also got out of the gate strong this week. The Russell 2000® Index (RUT) gained 1.2% to end at a four-week high but is still up just 1.7% for the year, while the S&P 500 has gained 8.6%.
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The origins of managed care can be traced back to at least 1929, when Michael Shadid, a physician in Elk City, Oklahoma, established a health cooperative for farmers in a small community without medical specialists or a nearby general hospital. He sold shares to raise money to establish a local hospital and created an annual fee schedule to cover the costs of providing care. By 1934, 600 family memberships were supporting a staff that included Dr. Shadid, four newly recruited specialists, and a dentist. That same year, two Los Angeles physicians, Donald Ross and Clifford Loos, entered into a prepaid contract to provide comprehensive health services to 2,000 employees of a local water company
Development of Prepaid Health Plans
Other major prepaid group practice plans were initiated between 1930 and 1960, including the Group Health Association in Washington, DC, in 1937, the Kaiser-Permanente Medical Program in 1942, the Health Cooperative of Puget Sound in Seattle in 1947, the Health Insurance Plan of Greater New York in New York City in 1947, and the Group Health Plan of Minneapolis in 1957. These plans encountered strong opposition from the medical establishment, but they also attracted a large number of enrollees.
Today, such prepaid health plans are commonly referred to as health maintenance organizations (HMOs). The term “health maintenance organization,” however, was not coined until 1970, with the aim of highlighting the importance that prepaid health plans assign to health promotion and prevention of illness. HMOs are what most Americans think of when the term “managed care” is used, even though other managed care models have emerged over the past 40 years.
Public Managed Care Plans
The enactment of the Health Maintenance Organization Act of 1973 (P. L. 93-222) provided a major impetus to the expansion of managed health care. The legislation was proposed by the Nixon Administration in an attempt to restrain the growth of health care costs and also to preempt efforts by congressional Democrats to enact a universal health care plan. P. L. 93-222 authorized $375 million to assist in establishing and expanding HMOs, overrode state laws restricting the establishment of prepaid health plans, and required employers with 25 or more employees to offer an HMO option if they furnished health insurance coverage to their workers. The purpose of the legislation was to stimulate greater competition within health care markets by developing outpatient alternatives to expensive hospital-based treatment. Passage of this legislation also marked an important turning point in the U.S. health care industry because it introduced the concept of for-profit health care corporations to an industry long dominated by a not-for-profit business model.
In the decade following the passage of P. L. 93-222, enrollment in HMOs grew slowly. Stiff opposition from the medical profession led to the imposition of regulatory restrictions on HMO operations. But the continued, rapid growth in health care outlays forced government officials to look for new solutions. National health expenditures grew as a proportion of the overall gross national product (GNP) from 5.3 percent in 1960 to 9.5 percent in 1980. In response, Congress in 1972 authorized Medicare payments to free-standing ambulatory care clinics providing kidney dialysis to beneficiaries with end-stage renal disease. Over the following decade, the Federal Government authorized payments for more than 2,400 Medicare procedures performed on an outpatient basis.
Responding to the relaxed regulatory environment, physicians began to form group practices and open outpatient centers specializing in diagnostic imaging, wellness and fitness, rehabilitation, surgery, birthing, and other services previously provided exclusively in hospital settings. As a result, the number of outpatient clinics skyrocketed from 200 in 1983 to more than 1,500 in 1991, and the percentage of surgeries performed in hospitals was halved between 1980 (83.7%) and 1992.
The Influence of Medicare Prospective Payments
Health care costs, however, continued to spiral upward, consuming 10.8 percent of GNP by 1983. In an attempt to slow the growth rate, Congress in 1982 capped hospital reimbursement rates under the Medicare program and directed the secretary of HHS to develop a case mix methodology for reimbursing hospitals based on diagnosis-related groups (DRGs). As an incentive to the hospital industry, the legislation (the Tax Equity and Fiscal Responsibility Act (P. L. 97-248)) included a provision allowing hospitals to avoid a Medicare spending cap by reaching an agreement with HHS on implementing a prospective payment system (PPS) to replace the existing FFS system. Following months of intense negotiations involving federal officials and representatives of the hospital industry, the Reagan Administration unveiled a Medicare PPS. Under the new system, health conditions were divided into 468 DRGs, with a fixed hospital payment rate assigned to each group.
Once the DRG system was fully phased in, Medicare payments to hospitals stabilized. However, since DRGs applied to inpatient hospital services only, many hospitals, like many group medical practices, began to expand their outpatient services in order to offset revenues lost as a result of shorter hospital stays. Between 1983 and 1991, the percentage of hospitals with outpatient care departments grew from 50 percent to 87 percent. Hospital revenues derived from outpatient services doubled over the period, reaching 25 percent of all revenues by 1992
Since DRGs were applied exclusively to Medicare payments, hospitals began to shift unreimbursed costs to private health insurance plans. As a result, average per employee health plan premiums doubled between 1984 and 1991, rising from $1,645 to $3,605. With health insurance costs eroding profits, many employers took aggressive steps to control health care expenditures. Plan benefits were reduced. Employees were required to pay a larger share of health insurance premiums. More and more employers—especially large corporations—decided to pay employee health costs directly rather than purchase health insurance. And a steadily increasing number of large and small businesses turned to managed health care plans in an attempt to rein in spiraling health care outlays.
Managed Long-Term Services and Supports
Arizona became the first state to apply managed care principles to the delivery and financing of Medicaid-funded LTSS in 1987, when the federal Health Care Financing Administration (later renamed the Centers for Medicare and Medicaid Services) approved the state’s request to expand its existing Medicaid managed care program. Medicaid recipients with physical and developmental disabilities became eligible to participate in the Arizona Long-Term Care System as a result of this program expansion. Over the following two decades, a number of other states joined Arizona in providing managed LTSS, and by the summer of 2012, 16 states were operating Medicaid managed LTSS programs
Growth of Commercial Managed Care Plans
During the late 1980s and early 1990s, managed care plans were credited with curtailing the runaway growth in health care costs. They achieved these efficiencies mainly by eliminating unnecessary hospitalizations and forcing participating physicians and other health care providers to offer their services at discounted rates. By 1993, a majority (51%) of Americans receiving health insurance through their employers were enrolled in managed health care plans. Eventually, however, benefit denials and disallowances of medically necessary services led to a public outcry and the enactment of laws in many states imposing managed care standards. According to one analysis, nearly 900 state laws governing managed health practices were enacted during the 1990s. Among the measures approved were laws permitting women to visit gynecologists and obstetricians without obtaining permission from their primary care physician, establishing the right of patients to receive emergency care, and establishing the right of patients to appeal decisions made by managed care firms. Congress even got into the act in 1997 when it passed the Newborns’ Mother Health Protection Act, prohibiting so-called “drive-through deliveries” (overly restrictive limits on hospital stays following the birth of a child).
Research studies have yielded little evidence that managed health care excesses have undermined the quality of health care services. For example, in a survey of 2,000 physicians, Remler and colleagues found that managed care insurance plans denied only about 1 percent of recommended hospitalizations, slightly more than 1 percent of recommended surgeries, and just over 2.5 percent of referrals to specialists. In another study, Franks and colleagues found that medical outcomes were similar for participants in HMOs versus FFS health plans. Franks also reported that HMO patients were hospitalized 40 percent less frequently than FFS patients, and the rate of inappropriate hospitalizations was lower among HMO patients.
Link: http://www.ncd.gov
More Recent Developments
Over the past 15 to 20 years, the public outcry against draconian managed care practices has waned, primarily due to the expanded out-of-network options afforded to participants in HMOs, PPOs, and POS health plans. But the perception that managed care represents an overly cost-conscious, mass market approach to delivering medical services lingers among the American public, even though more than 135 million people with health insurance coverage now receive their primary, preventive, and acute health services through a managed care plan. People with disabilities, especially high users of medical care and LTSS, share many of the same negative perceptions of managed care as the general public.
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Conclusion
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Humana Plans to Leave Some Medicare Advantage Markets in 2025
Humana expects to exit Medicare Advantage (MA) markets in 2025, company executives told investors. The company reported its first quarter earnings April 24th. Humana posted $741 million in net income in the first quarter of 2024, beating investor expectations, but pulled its 2025 earnings guidance.
On an April 24th 2024 call with investors, Humana executives said it will look to pull back benefits and exit some markets, as CMS continues phasing in risk adjustment changes. CMS published its final MA rate notice for 2025 earlier this month. The agency slightly cut benchmark payments and continued phasing in coding changes. Humana previously said the agency’s rates were lower than its expectations.
Other payers have signaled they will likely cut benefits to accommodate the rate notice.
Source: Rylee Wilson, Becker’s Payer Issues [4/25/24]
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Dr. David Edward Marcinko MBA MEd CMP
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National Supply Chain Management Day is celebrated on April 29th every year to mark the binding importance of the global supply chain in the everyday lives of people. National Supply Chain Day brings all stakeholders together to share recent developments in the field. Introduced in 2020 by a Georgia-based packaging outlet, this holiday aims to raise awareness about the way a supply chain affects all of us, and how we can be better partners and benefactors of the global supply chain management system.
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One of the most iconic symbols of the COVID economy was the epic backlog of container ships waiting to dock at the ports of Los Angeles and Long Beach. At one point this year, that backup was longer than the line at Trader Joe’s on a Saturday, stretching 109 ships deep and almost 60 miles from the coast.
But now, the shipping situation is almost back to normal. As of last week, the number of ships waiting to drop off their goods stood at just four, according to the WSJ. Plus, the cost of sending a 40-foot container from Shanghai to LA has plummeted from its peak of more than $12,000 to almost $2,000, nearing its pre-COVID average.
The fact that goods are once again flowing smoothly through US ports is a hopeful sign that inflation, which was instigated in part by supply chain snarls, could start to abate.
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MACHINE LEARNING AND NATURAL LANGUAGE PROCESSING
By Eric Bricker MD
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INTRODUCING OUR NEXT GENERATION e-BOOK LIBRARY FROM iMBA, Inc.
An e-book is an electronic or digital book that can be read on a computer or a handheld device.
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With no manufacturing, printing, binding or shipping costs, e-Books are cheaper than traditional hard or paper back books.The price of each specialized and highly niche focused e-Book [50-100 pages] is only $25, whereas similar paperback printed books of this type generally cost $145, or more!
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MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING
“Worried about an IRS audit? Avoid what’s called a red flag. That’s something the IRS always looks for. For example, say you have some money left in your bank account after paying taxes. That’s a red flag.“
― Jay Leno
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
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HAPPY APRIL 15th 2024
Americans are saving less at their lowest pace in more than a year, and are apparently spending more than the growth of their incomes, according to an analysis by Wells Fargo that was shared with Newsweek.
In February, the personal savings rate hit 3.6 percent, “marking the lowest rate at which households saved in 14 months,” Wells Fargo economists noted in the Thursday report, adding that spending outpaced income growth for the month. The savings rate is higher than the below 3 percent level it fell to following the COVID-19 pandemic, but is nevertheless way down from the pre-pandemic rate of 6 percent.
CITE: https://www.r2library.com/Resource
The deadline for most people to file a 2023 tax return with the IRS is fast approaching; returns are due by 11:59 p.m., in your time zone, on Monday, April 15th today, with some exceptions. Taxpayers in Massachusetts and Maine have until April 17th to file and pay taxes because of the Patriots’ Day and Emancipation Day holidays. There are also extensions in some areas impacted by extreme weather. Individuals and businesses impacted by the October 7th attack on Israel have also been given an extension, the IRS announced. There are extensions for certain active-duty military members and citizens living abroad.
CITE: https://tinyurl.com/2h47urt5
Nike announced plans to lay off around 1,600 employees, or about 2% of its global workforce, as part of a $2 billion cost-cutting strategy. CEO John Donahoe said performance has not been the best and took responsibility. Donahoe said, “This is a painful reality and not one that I take lightly.”
CITE: https://tinyurl.com/tj8smmes
Stellantis is the world’s fourth-largest automaker by sales, behind Toyota, Volkswagen Group, and Hyundai Motor Group. The company designs, manufactures, and sells automobiles bearing its 14 brands: Abarth, Alfa Romeo, Chrysler, Citroën, Dodge, DS, Fiat, Jeep, Lancia, Maserati, Opel, Peugeot, Ram, and Vauxhall. Their headquarters is located in Amsterdam, and they have over 300,000 employees in 130 countries.
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The Biden administration wants to make changes to private Medicare insurance plans that officials say will help seniors find plans that best suit their needs, promote access to behavioral health care and increase use of extra benefits such as fitness and dental plans. “We want to ensure that taxpayer dollars actually provide meaningful benefits to enrollees,” said Health and Human Services Secretary Xavier Becerra. If finalized, the proposed rules rolled out Monday could also give seniors faster access to some lower-cost drugs. Administration officials said the changes, which are subject to a 60-day comment period, build on recent steps taken to address what they called confusing or misleading advertisements for Medicare Advantage [Part C] plans. Just over half of those eligible for Medicare get coverage through a private insurance plan rather than traditional, government-run Medicare.
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Healthcare varies substantially by state based on dozens of factors. The same is valid for cities. Some of this is due to the availability of medical facilities. Some have to do with health habits. Some have to do with incomes and poverty levels. People who live in poor states, based on income, almost always have unhealthy populations. A new study from Renew Bariatrics shows the “Healthiest (and Unhealthiest) States in the US—2024 Rankings,” and reviews alcohol use, diabetes, drug overdoses, mental health, isolation, tobacco use, exercise, and the presence of heart disease, obesity, and cancer. These, taken together, create an index from 0 to 100, with 100 being the worst possible score. These are the most expensive states to live in.
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Colleagues know that I enjoy personal coaching and public speaking and give as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.
These include lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.
Topics Link: imba-inc-firm-services
My Fond Farewell to Tuskegee University
And so, we appreciate your consideration.
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By Dr. David E. Marcinko MBA MEd CMP
[Editor-in-Chief]
According to economist Austin Frakt PhD, and others, there is a school of thought that says Congress is incapable of controlling costs in the Medicare and Medicaid System [CMS].
And, then there is the reality known by all practicing medical professionals regardless of specialty orientation or degree designation. That is to say, CMS really can control healthcare costs and with great ferocity and efficiency, and to non-public sectors as well …. PARADOXICAL?
On Getting What You Wish For
Blogger Ezra Klein opines that one of the dirty little secrets of the health-care system is that Medicare has done a much better job controlling costs than private health insurers.
http://voices.washingtonpost.com/ezra-klein/2010/11/what_happens_when_medicare_con.html
A Forehead-Palm Moment
Of course, we doctors know that the real problem is that Medicare seemingly [think Seinfeld’s character George Costanza] controls costs all too well; but not really. It is just that CMS pays doctors too little and thus it appears costs are controlled. What really is happening is that physician fees are being reduced carte’ blanche.
Nevertheless, and regardless of semantics, CMS will never control costs much more efficiently than private insurance companies or doctors will simply abandon Medicare for related payment models like direct reimbursement or concierge medicine. This is happening right now. Physicians, osteopaths and podiatrists etc, are opting out of Medicare in increasingly large numbers. In a world where there’s only Medicare and Medicare to control costs, doctors can either take the pay cut or stop seeing patients, and stop being doctors. “Taking what they are given – because they’re working for a livin.”
So sorry that this seems like a forehead-palm moment for Ezra, but not for healthcare practitioners or the ME-P!
Too Much Demand Elsewhere
And, as we see from other countries, many young bright folks want to be doctors, even if being a doctor doesn’t make one particularly wealthy [high demand and high eventual supply produces lower provider costs in the long term?]. Think medical tourism.
Not so much the case anymore in this country [lower demand and lower eventual supply produces higher reimbursement costs to the doctor survivors in the very long term?].
Our Domestic World
But, we are not elsewhere. In fact, in our present domestic healthcare ecosystem, when Medicare decides to control costs, many doctors can simply stop accepting Medicare patients, and the politicians will lose their jobs. One political party then declares that Medicare is rationing and will hurt senior citizens. The other party capitulates and pays MDs more [SGR]. Then, the federal budget looks bad as it does now. The circle is complete when one party asserts that Medicare actually can’t contain costs but the private insurance companies will. It all fails, in an unending circular Boolean-like loop of illogic.
Listen Up!
So, listen up AARP, politicians, CMS and seniors as I admonish you to be careful what you wish for [medical cost controls]. It might just come true. As Ezra rightly says; rinse, repeat – rinse, repeat – ad nausea. You simply can’t have it both ways. You either choose to spend less and offend certain cohorts, or spend more and offend different factions. Either way, you’re going to piss someone off. A good healthcare reimbursement system would try to make that decision rationally [a-politically]. But, at least it would make an economics driven decision; wouldn’t it?
Assessment
Is CMS really the eight hundred pound cost-controlled gorilla in the increasingly large Medicare treatment room? Why or why not? Now, relative to the ACA of 2010, please read: The Case for Public Plan Choice in National Health Reform [Key to Cost Control and Quality Coverage], by Jacob S. Hacker, PhD. Link: Jacob Hacker Public Plan Choice
Conclusion
And so, your thoughts and comments on this ME-P are appreciated. Do we have a Medicare cost control efficiency paradox? Or, are the economists just reveling in the publication banal? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
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Most doctors report feeling overworked and are considering a change in career, according to a new poll.
Doximity, a virtual network for physicians, found that 81% doctors surveyed last fall said they felt overworked—a slight decline from 86% who reported burnout in 2022 but still up from 73% in 2021. Meanwhile, about three in five doctors said they were considering early retirement (30%), looking for another employer (15%), or leaving the profession altogether (14%), the poll found.
The findings, released this week, come amid reports of rising rates of physician burnout and dissatisfaction since the Covid-19 pandemic.
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[THE MILLION DOLLAR MISTAKE]
By Curtis G. Graham MD
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The fact that every physician in private medical practice, without a business education, leaves approximately a million dollars on the table and is unaware of it is well known to business experts who work with medical doctors experiencing financial difficulties.
Business experts such as Dan S. Kennedy, Peter Drucker, Michael Gerber, Maxwell Maltz, Neil Baum, William Hanson, Huss and Coleman, Steven Hacker, Thomas Stanley, Chris Hurn, Napoleon Hill, and Dave Ramsey, among others, understand the financial problems faced by medical practices and how to solve them.
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Filed under: "Doctors Only", Career Development, Experts Invited, Financial Planning, Health Economics, Healthcare Finance, Insurance Matters, Investing, Managed Care, Op-Editorials, Practice Management, Retirement and Benefits, Risk Management, Touring with Marcinko | Tagged: business, Chris Hurn, Curtis Graham MD, Dan S. Kennedy, Huss and Coleman, kevin pho, KevinMD, Marcinko, Marcinko Associates, Maxwell Maltz, medical schools, Michael Gerber, Napoleon Hill, Neil Baum, Peter Drucker, Steven Hacker, Thomas Stanley, Why medical schools don’t teach business, Why they Don’t Teach Business, William Hanson | Leave a comment »
By Staff Reporters
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Finance, economics and management essays of most current interest to all physicians and healthcare professionals
READ ESSAYS: https://marcinkoassociates.com/articles-essays/
Check back periodically for practical updates. Our catalogue library of major books, texts, case models and dictionaries is suggested for additional financial, economic, business and medical practice management information and education.
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By Health Capital Consultants, LLC
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On December 26, 2023, a study published in the Journal of the American Medical Association (JAMA) found concerning changes in patient outcomes and hospital adverse events associated with private equity (PE) acquisition and ownership of hospitals. Over the past ten years, PE firms have set their sights on hospitals as a lucrative investment opportunity, spending nearly $1 trillion to finance healthcare acquisitions, and purchasing more than 200 hospitals from non-PE owners.
CITE: https://www.r2library.com/Resource
This Health Capital Topics article reviews the JAMA study and the impact of PE ownership on the healthcare industry. (Read more…)
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By Staff Reporters
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Pharmaceutical companies have filed a slew of suits around the country to get federal judges to invalidate a government program aimed at lowering drug costs for seniors by allowing Medicare to negotiate prices, as is the norm in many other countries, according to the Washington Post. The companies argue it’s unconstitutional and would inhibit their ability to develop new treatments.
CITE: https://www.r2library.com/Resource
The Federal Reserve is looking for steady, reliable signs that inflation is simmering down before it cuts interest rates this year. So far, 2024 has not delivered. Data released by the Bureau of Labor Statistics on Tuesday showed prices rose 3.2 percent over last year, slightly outpacing forecasts of 3.1 percent. Prices also rose 0.4 percent in February over the previous month — in line with expectations, but still hotter than economists would like to discern.
Stocks swung up on Tuesday as investors shrugged off a middling inflation report and looked ahead to next week’s Fed meeting. Meanwhile, Oracle went sky-high, posting its best day since 2021 after demand for AI prompted a huge increase in sales for its cloud computing business.
Here’s where the major benchmarks ended:
Chip makers’ bounce-back helped boost the Philadelphia Semiconductor Index (SOX) more than 2%, as it recovered part of a 5% drop the previous two trading days. Industry leader Nvidia (NVDA) jumped over 7%. Consumer discretionary and communications services shares were also among the strongest areas. Regional banks and real estate were among the weakest sectors as the CPI data spurred an upturn in Treasury yields.
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Three healthcare industry groups—America’s Health Insurance Plans (AHIP), the American Medical Association (AMA), and the National Association of Accountable Care Organizations (NAACOS)—released the 36-page playbook on July 25th, 2023. Adoption of the best practices in the playbook is voluntary; the playbook is intended to encourage the adoption of value-based care arrangements in the private sector, according to a news release from the three groups.
CITE: https://www.r2library.com/Resource
Under a value-based care model, providers are reimbursed based on patient outcomes rather than the quantity of services provided like in the traditional fee-for-service model. The value-based care model has been around since the late 1960s. But, widespread adoption has been slow—less than half of the primary care physicians said in a 2022 survey from the Commonwealth Fund that they had received any value-based payments.
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ACCOUNTABLE CARE ORGANIZATION EXAMPLE
BY DR. DAVID EDWARD MARCINKO MBA CMP®
http://www.MARCINKOASSOCIATES.com
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What is an ACO?
ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.
Citation: https://www.r2library.com/Resource/Title/0826102549
Case Model
Now, suppose that in a new Accountable Care Organization [ACO] contract, a certain medical practice was awarded a new global payment or capitation styled contract that increased revenues by $100,000 for the next fiscal year. The practice had a gross margin of 35% that was not expected to change because of the new business. However, $10,000 was added to medical overhead expenses for another assistant and all Account’s Receivable (AR) are paid at the end of the year, upon completion of the contract.
Cost of Medical Services Provided (COMSP):
The Costs of Medical Services Provided (COMSP) for the ACO business contract represents the amount of money needed to service the patients provided by the contract. Since gross margin is 35% of revenues, the COMSP is 65% or $65,000. Adding the extra overhead results in $75,000 of new spending money (cash flow) needed to treat the patients. Therefore, divide the $75,000 total by the number of days the contract extends (one year) and realize the new contract requires about $ 205.50 per day of free cash flows.
Assumptions
Financial cash flow forecasting from operating activities allows a reasonable projection of future cash needs and enables the doctor to err on the side of fiscal prudence. It is an inexact science, by definition, and entails the following assumptions:
Physician Reactions:
Since many physicians are still not entirely comfortable with global reimbursement, fixed payments, capitation or ACO reimbursement contracts; practices may be loath to turn away short-term business in the ACA era. Physician-executives must then determine other methods to generate the additional cash, which include the following general suggestions:
1. Extend Account’s Payable
Discuss your cash flow difficulties with vendors and emphasize their short-term nature. A doctor and her practice still has considerable cache’ value, especially in local communities, and many vendors are willing to work them to retain their business
2. Reduce Accounts Receivable
According to most cost surveys, about 30% of multi-specialty group’s accounts receivable (ARs) are unpaid at 120 days. In addition, multi-specialty groups are able to collect on only about 69% of charges. The rest was written off as bad debt expenses or as a result of discounted payments from Medicare and other managed care companies. In a study by Wisconsin based Zimmerman and Associates, the percentages of ARs unpaid at more than 90 days is now at an all time high of more than 40%. Therefore, multi-specialty groups should aim to keep the percentage of ARs unpaid for more than 120 days, down to less than 20% of the total practice. The safest place to be for a single specialty physician is probably in the 30-35% range as anything over that is just not affordable.
The slowest paid specialties (ARs greater than 120 days) are: multi-specialty group practices; family practices; cardiology groups; anesthesiology groups; and gastroenterologists, respectively. So work hard to get your money, faster. Factoring, or selling the ARs to a third party for an immediate discounted amount is not usually recommended.
3. Borrow with Short-Term Bridge Loans
Obtain a line of credit from your local bank, credit union or other private sources, if possible in an economically constrained environment. Beware the time value of money, personal loan guarantees, and onerous usury rates. Also, beware that lenders can reduce or eliminate credit lines to a medical practice, often at the most inopportune time.
4. Cut Expenses
While this is often possible, it has to be done without demoralizing the practice’s staff.
5. Reduce Supply Inventories
If prudently possible; remember things like minimal shipping fees, loss of revenue if you run short, etc.
6. Taxes
Do not stop paying withholding taxes in favor of cash flow because it is illegal.
Hyper-Growth Model:
Now, let us again suppose that the practice has attracted nine more similar medical contracts. If we multiple the above example tenfold, the serious nature of potential cash flow problem becomes apparent. In other words, the practice has increased revenues to one million dollars, with the same 35% margin, 65% COMSP and $100,000 increase in operating overhead expenses. Using identical mathematical calculations, we determine that $750,000 / 365days equals $2,055.00 per day of needed new free cash flows! Hence, indiscriminate growth without careful contract evaluation and cash flow analysis is a prescription for potential financial disaster.
ASSESSMENT: Your comments are appreciated.
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By Staff Reporters
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Walgreens tapped Mary Langowski, a former CVS Health executive, to lead its U.S. healthcare segment. The move comes as the retail pharmacy giant looks to boost profitability in its healthcare business.
CVS Health cut its outlook for 2024 on the back of higher medical costs in the fourth quarter. The drugstore chain, which owns Aetna, joins other healthcare companies to see a spike in utilization.
And … following up on a federal law passed in September to increase competition among organ transplant contractors, HRSA is issuing requests for proposals for several different contracts.
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By Eric Bricker MD
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MARCINKO & ASSOCIATES, Inc.
Dr. David Edward Marcinko MBA CMP®
Certified Medical Planner®
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FINANCIAL PLANNING
CAREER DEVELOPMENT
MEDICAL PRACTICE BUY IN / OUT
INVESTMENT ANALYSIS
PORTFOLIO MANAGEMENT
MERGERS AND ACQUISITIONS
PRACTICE APPRAISALS AND VALUATIONS
RETIREMENT PLANNING
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By Staff Reporters
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The Cigna Group (NYSE:CI) has announced leadership changes designed to continue accelerating growth across Evernorth Health Services and Cigna Healthcare.
Brian Evanko to continue as CFO, will serve as new President and CEO of Cigna Healthcare and Ann Dennison to join The Cigna Group as Deputy CFO.
Here’s where the major benchmarks ended:
Real estate and utility shares were among the market’s weakest performers Wednesday, with the Dow Jones Utility Average (DJU) losing 1.4% and ending at its lowest level since late November. Small-cap stocks also remained under pressure. The Russell 2000® Index (RUT) fell 0.7% and ended at a five-week low. In other markets, the U.S. Dollar Index (DXY) strengthened to a five-week high as the retail sales report fueled optimism over the economy.
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States that have long pushed the FDA to allow drug importation from Canada touted the move as a major step forward in their efforts to lower prescription drug spending and rein in healthcare costs. But while the idea of importing drugs from Canada is new for states, some businesses have been using existing drug import pathways to help consumers save money on certain high-cost medications.
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More than 20 million US residents—a record number, according to the Biden administration—have signed up for health insurance through the Affordable Care Act’s marketplaces. (the New York Times)
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Here’s where the major benchmarks ended:
Stocks were a mixed bag yesterday as investors pored over the first big earnings reports and new data showing that wholesale prices surprisingly went down in December. Airlines took a hit after Delta beat earning expectations but lowered its profit forecast.
Retailers and consumer discretionary shares were among the market’s weakest performers Friday, and regional banks were also under pressure. The KBW Regional Banking Index (KRX) fell 2% for the week and ended at a one-month low. Energy shares led gainers behind strength in crude oil futures. The small-cap-focused Russell 2000® Index (RUT) ended little-changed for the week but is still down 3.8% so far this year.
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MARCINKO & ASSOCIATES, Inc.
SPONSOR: http://www.MARCINKOASSOCIATES.com
Dr. David Edward Marcinko MBA CMP®
Certified Medical Planner®
SPONSOR: http://www.CertifiedMedicalPlanner.org
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FINANCIAL PLANNING
CAREER DEVELOPMENT
MEDICAL PRACTICE BUY IN / OUT
INVESTMENT ANALYSIS
PORTFOLIO MANAGEMENT
MERGERS AND ACQUISITIONS
PRACTICE APPRAISALS AND VALUATIONS
RETIREMENT PLANNING
FEE-ONLY
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CONTACT: Ann Miller RN MHA
EMAIL: MarcinkoAdvisors@msn.com
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Filed under: "Doctors Only", Alternative Investments, Career Development, CMP Program, Ethics, Financial Advisor Listings, Financial Planning, iMBA, Inc., Investing, LifeStyle, Managed Care, Marketing & Advertising, Portfolio Management, Practice Management, Practice Worth, Touring with Marcinko | Tagged: acquisitions, David Edward Marcinko, expert witness, fiduciary, Financial Planning, Investing, mergers, opinions, Portfolio Management, retirement planning, second opinions | Leave a comment »
FEE FOR SERVICE
By Eric Bricker MD
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Filed under: "Doctors Only", Ethics, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Managed Care, Videos | Tagged: accountabkle care organization, ACO, Eric Bricker JD, fee for service, FFS, value based care, VBC | Leave a comment »
By Staff Reporters
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Supermarket chain Kroger is moving into primary care for seniors. The company is partnering with Better Health Group to test out a value-based, primary care model at eight of its in-store clinics in Atlanta.
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As the Artificial Intelligence race heats up, Google unveiled this week new AI models called MedLM purpose-built for healthcare use cases like summarizing patient-doctor interactions. HCA Healthcare is already testing out the technology.
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And … Cigna is attracting plenty of interest for the rumored sale of its Medicare Advantage business, Bloomberg reported, here: who’s competing to scoop up the MA segment.
CITE: https://www.r2library.com/Resource/Title/082610254
Finally, more than two dozen healthcare payers and providers are making voluntary safety, security and transparency commitments to the White House regarding the use of artificial intelligence.
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Filed under: Alerts Sign-Up, Drugs and Pharma, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., LifeStyle, Managed Care | Tagged: ACA, AI, better health group, Bloomberg, Cigna, CVs, google, Kroger, Medicare Advantage, Oscar, Part C., VBC | Leave a comment »
[Transformational Health 2.0 Skills for Savvy Doctors]
By Ann Miller RN MHA [Executive-Director]
For the first time anywhere, we offer our loyal ME-P readers and subscribers an exclusive first look at the new book: The “Business of Medical Practice” from the Institute of Medical Business Advisors Inc, in Atlanta, GA www.MedicalBusinessAdvisors.com
Synopsis
Now in its 3rd edition, the book explores a variety of issues and seeks to answer these questions:
A Tool for all Stakeholders
Answering these questions and more, this newly updated and revised edition is an essential tool for doctors, nurses, and healthcare administrators; management and business consultants; accountants; and medical, dental, business, and healthcare administration graduate, doctoral students and virtually all stakeholders of the healthcare industrial complex.
Management and Operational Strategies for Private Practice
Written in plain language using nontechnical jargon, the text presents a progressive discussion of management and operation strategies. It incorporates prose, news reports, and regulatory and academic perspectives with Health 2.0 examples, and blog and internet links, as well as charts, tables, diagrams, and Web site references, resulting in an all-encompassing resource. It integrates various medical practice business disciplines-from finance and economics to marketing to the strategic management sciences-to improve patient outcomes and achieve best practices in the healthcare administration field. With contributions by a world-class team of expert authors, the third edition covers brand-new information, including:
Front Matter: Front Matter BoMP – 3
Assessment
Please send any question/and or comments directly to us at: MarcinkoAdvisors@msn.com
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Filed under: Book Reviews, Breaking News, Experts Invited, Health Economics, Information Technology, Managed Care, Practice Management, Practice Worth, Quality Initiatives, Recommended Books | Tagged: business appraisals, Business Medical Practice, Marcinko, medical clinics | 1 Comment »
MANAGEMENT SERVICE ORGANIZATION
By Health Capital Consultants, LLC
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Valuation of MSOs: Introduction & Competitive Environment
DEFINITION: A management services organization is an outside entity that can help with the non-medical parts of running a medical practice, out-patient facility or clinic; etc.
CITE: https://www.r2library.com/Resource/Title/082610254
Management service organizations (MSOs) can be defined as “a healthcare specific administrative and management engine that provides a host of administrative and management functions necessary to be successful in the ever changing healthcare environment.” MSOs are primarily utilized by non-physicians as a vehicle to legally owning an entity that provides administrative support to a medical practice’s operations.
Most states only allow medical practices to be owned by physicians, which can limit the number of investors in a medical practice, as well as the financial value of the practice. (Read more…)
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Filed under: Career Development, Experts Invited, Health Economics, Healthcare Finance, Managed Care, Professional Liability, Research & Development | Tagged: Health Capital Consultants, management service organization, MSO, MSOs | Leave a comment »
WHAT WE DO AND HOW WE ASSIST MEDICAL COLLEAGUES
Hard Business Advice AND Personal Lifestyle Coaching
http://www.MARCINKOASSOCIATES.com
By Ann Miller RN MHA CMP™
At Marcinko & Associates our clients traditionally include physicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
***
But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
***
Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
***
http://www.DavidEdwardMarcinko.com
CONTACT US TODAY – THRIVE TOMORROW!
Suite #5901 Wilbanks Drive
Norcross, Georgia USA 30092-1141
email: MarcinkoAdvisors@msn.com
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Filed under: "Advisors Only", "Ask-an-Advisor", "Doctors Only", Accounting, Career Development, Estate Planning, Ethics, Experts Invited, Financial Advisor Listings, Financial Planning, Health Economics, Health Law & Policy, Healthcare Finance, Interviews, Investing, LifeStyle, Managed Care, Marketing & Advertising, Media Mentions and PR, mental health, Op-Editorials, Practice Management, Practice Worth, Risk Management, Sponsors, Touring with Marcinko | Tagged: advising, coaching, David Edward Marcinko, david marcinko, Dr. David Edward Marcinko, Dr. Marcinko, Marcinko advisors, Marcinko Associates, psychology | Leave a comment »
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Filed under: "Doctors Only", Experts Invited, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology, Managed Care, Quality Initiatives | Tagged: LPN, NP, nurses, nursing, Nursing Innovation, Nursing Trends, RN, Wayne Gregory | 1 Comment »
WHAT WE DO AND HOW WE ASSIST MEDICAL COLLEAGUES
Hard Business – Financial Advice AND Personal Lifestyle Coaching
http://www.MARCINKOASSOCIATES.com
***
By Ann Miller RN MHA CMP™
At Marcinko & Associates our clients traditionally include physicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
***
But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
***
Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
***
***
CONTACT US TODAY – THRIVE TOMORROW!
Suite #5901 Wilbanks Drive
Norcross, Georgia USA 30092-1141
email: MarcinkoAdvisors@msn.com
***
***
Filed under: "Advisors Only", "Ask-an-Advisor", "Doctors Only", Accounting, Career Development, Estate Planning, Ethics, Experts Invited, Financial Advisor Listings, Financial Planning, Health Economics, Health Law & Policy, Healthcare Finance, Interviews, Investing, LifeStyle, Managed Care, Marketing & Advertising, Media Mentions and PR, mental health, Op-Editorials, Practice Management, Practice Worth, Risk Management, Sponsors, Touring with Marcinko | Tagged: advising, coaching, David Edward Marcinko, david marcinko, Dr. David Edward Marcinko, Dr. Marcinko, Marcinko advisors, Marcinko Associates, psychology | Leave a comment »
HSAs and FSAs
By Staff Reporters
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As cold and flu season truly sets in, major home delivery platforms are now allowing customers to purchase products using their health benefits.
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Two major healthcare deals closed last week, including a $3 billion merger between Virgin Pulse and third-party administrator HealthComp, on the heels of a relatively quiet year for healthcare M&A deals.
CITE: https://www.r2library.com/Resource
And … Redesign Health has launched Harmonic Health. The digital health company’s care team will partner with PCPs, neurologists, healthcare systems and ACOs to deliver comprehensive dementia care.
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Filed under: "Ask-an-Advisor", "Doctors Only", Alerts Sign-Up, Breaking News, Experts Invited, Funding Basics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology, Managed Care, Practice Management | Tagged: ACO, ACOs, dementia, Fierce Health Finance, FSA, FSAs, Harmonic Health, HealthComp, HSA, HSAs, neurologists, PCPs, Redesign Health, VBC, Virgin Pulse | Leave a comment »
By Staff Reporters
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House Democrats want CMS to better monitor Medicare Advantage plans’ use of AI tools to ensure they don’t allow an unusually high level of restrictive and repeated denials.
Kaiser Permanente continues to rebound from a rough 2022 and pulled in $239 million in net income in Q3. That marks a dramatic turnaround from the $1.5 billion net loss the integrated system had seen a year prior.
CITE: https://www.r2library.com/Resource
And … during the Milken Institute’s Future of Health Summit Monday, former HHS Secretary Alex Azar and current department chief Xavier Becerra sparred over the Biden administration’s approach to negotiating Medicare drug prices.
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Finally, family physicians utilizing value-based payment (VBP) models reported burnout relief in a study from EHR company Elation Health and the American Academy of Family Physicians. Burnout among providers decreased once practices passed a threshold of 75% financial investment in VBP models.
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Filed under: "Doctors Only", Accounting, Breaking News, Drugs and Pharma, Ethics, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology, Insurance Matters, Managed Care, Risk Management, Taxation | Tagged: ACOs, AI, Alex, Alex Azar, CMS, eHR, family physicians, Fierce Healthcare, HHS, Kaiser Permanente, Milken Institute, value based care, VBC, VBP | Leave a comment »
JUST ANNOUNCED
By Staff Reporters
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The Biden administration wants to make changes to private Medicare insurance plans that officials say will help seniors find plans that best suit their needs, promote access to behavioral health care and increase use of extra benefits such as fitness and dental plans.
PART C FRAUD: https://medicalexecutivepost.com/2023/10/24/podcast-medicare-advantage-part-c-fraud/
MEDICARE ADVANTAGE ALLEGATIONS: https://medicalexecutivepost.com/2022/09/06/medicare-part-c-advantage-plan-allegations-investigations/
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Filed under: "Doctors Only", Breaking News, Career Development, Managed Care, Risk Management | Tagged: medcare advantage, medicare, Medicare C, Medicare Part C, Part C, private medicare | Leave a comment »
MARCINKO ASSOCIATES, Inc.
SPONSOR: http://www.MarcinkoAssociates.com
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The Marcinko & Associates case study and white-paper compendium is a teaching vehicle that presents potential clients with a critical management issue that serves as a spring board to lively debate in which participants present and defend their analysis and prescriptions. The average case is 2 to 100 pages long (prose, tables, graphs, charts, spread sheets and figures, etc).
CASE MODEL Sample Privatization: https://tinyurl.com/3af5nf7s
ORDER: https://marcinkoassociates.com/case-studies/
THANK YOU
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Filed under: "Advisors Only", "Doctors Only", Career Development, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Managed Care, Marketing & Advertising, Op-Editorials | Tagged: business, case models, case reports, case studies, entities, healthcare, healthcare business, healthcare business entities, Management | Leave a comment »
By David Edward Marcinko MBA CMP™
***
SPONSOR: http://www.MARCINKOASSOCIATES.com
Merging Medical Practices
There are only three possibilities if you want to go into practice for yourself; buy a practice; franchise a business, or start one. However, if you have an existing practice, merging it to form a larger entity can be a satisfying experience. The pace of practice mergers is accelerating, but it is often difficult to make an informed judgment about synergy. Mergers make sense only if the resulting value is more than additive to the original; not duplicative.
CITE: https://www.r2library.com/Resource
Unfortunately, far too many mergers fail to create, or actually destroy existing value. So, look for complimentary processes, personalities and ideas. In a merger of two existing practices, there is no substitute for personal interaction between employees and physician-management. This creates cross-pollination and new ideas in everything from service-lines and the patient production process, to marketing and finance, and to proprietary and intellectual rights. Most importantly, it allows
diversity of ideas.
And so, the following are questions to consider when contemplating a medical practice
merger:
What are the risks of this transaction and how are they mitigated?
Will talented employees be retained on both sides and can an exodus be
prevented?
Are the specific liabilities of each practice known? Remember, the farther outside
your area of specialty or expertise, the greater the risk of being wrong.
Will I appraise each practice independently, and correctly?
Where will employee allegiance rest?
What is the name, and logo, of the new entity? Who will be the CEO?
Vertical Integration: https://medicalexecutivepost.com/2023/04/14/integration-as-a-competitive-strategy-in-healthcare-reform/
More: https://medicalexecutivepost.com/2022/06/19/healthcare-mergers-acquisitions-2021-in-review/
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Filed under: "Ask-an-Advisor", "Doctors Only", Accounting, Health Economics, Healthcare Finance, Interviews, Managed Care, Marcinko Associates, Touring with Marcinko | Tagged: M&As, medical practice acquisitions, Medical practice M&As, medical practice mergers, medical practice vertical integration, Medical Vertical Integration, vertigal integration | Leave a comment »
By Dr. David Edward Marcinko MBA CMP
SPONSOR: http://www.MarcinkoAssociates.com
What is population health management?
The Care Continuum Alliance, an alliance of stakeholders across the continuum of care, is working precisely toward the goal of improving the health of populations. They espouse a detailed set of principles and a model of “population health management.” It can be summed up, in the broadest sense, as the care provider community, in partnership with patients and their families, conducting proactive and collective monitoring of the patient’s healthcare quality, adherence, access, and outcomes with the goal of improving the health of an entire patient population.
As such, population health management stresses wellness and prevention through lifestyle and disease management and complex case management to remove the gap between zero care and costly chronic or emergency care. It emphasizes the full spectrum of needs from prevention and wellness to keeping healthy people and at-risk people healthy, to better manage the care of those with chronic conditions, and to still be ready to provide emergent or acute care services. In most cases, it also includes the involved providers taking on accountability for the financial risk and quality of care provided.
We have been working with administrative and physician leaders across the country to grapple with what it will mean to actually foster valuable population health management in the different communities they serve. It is clear that this is a whole new paradigm and that the years of experience and training that have brought them to where they are today may not have sufficiently prepared them for what is to come. It requires a well-coordinated and complete continuum of care, with new metrics and advanced analytics. As one might expect,while clusters of resistance to the idea remain, most have flung themselves into learning mode and are beginning to “act their way into new thinking.”
However, we also see a big risk in powering ahead without revisiting the role of a key stakeholder group—patients and their families, whose experience and perspective are often left behind, but whose actions will have a profound effect on the future success of population health management efforts.
CITE: https://www.r2library.com/Resource
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Its earnings season once again and CVS Health beat Wall Street estimates with $2.3 billion in profit during Q3. Humana raised its Medicare Advantage enrollment projections again.
And, population management telehealth giant Amwell inked a major federal contract but has seen its losses balloon in 2023.
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Filed under: "Doctors Only", Career Development, CMP Program, Health Law & Policy, Information Technology, Managed Care, Op-Editorials, Quality Initiatives, Touring with Marcinko, Videos | Tagged: Amwell, Certified Medical Planner™, CMP, CVs, CVS Health, david marcinko, Eric Bricker, Humana, Marcinko Associates, Population Health, population health management, public health, tele health | Leave a comment »
By Eric Bricker MD
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Filed under: "Doctors Only", Career Development, Drugs and Pharma, Experts Invited, Health Economics, Health Insurance, Interviews, Managed Care, Practice Management, Videos | Tagged: elion healthcare, elon, elon musk, Eric Bricker, managed care treatment algorithms, musk, musk healthcre | Leave a comment »
MARCINKO ASSOCIATES, Inc.
SPONSOR: http://www.MarcinkoAssociates.com
***
***
The Marcinko & Associates case study and white-paper compendium is a teaching vehicle that presents potential clients with a critical management issue that serves as a spring board to lively debate in which participants present and defend their analysis and prescriptions. The average case is 2 to 100 pages long (prose, tables, graphs, charts, spread sheets and figures, etc).
CASE MODEL Sample Privatization: https://tinyurl.com/3af5nf7s
ORDER: https://marcinkoassociates.com/case-studies/
THANK YOU
***
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Filed under: "Advisors Only", "Doctors Only", Career Development, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Managed Care, Marketing & Advertising, Op-Editorials | Tagged: business, case models, case reports, case studies, entities, healthcare, healthcare business, healthcare business entities | Leave a comment »
WHAT WE DO AND HOW WE ASSIST MEDICAL COLLEAGUES
Hard Business Advice AND Personal Lifestyle Coaching
http://www.MARCINKOASSOCIATES.com
By Ann Miller RN MHA CMP™
At D.E. Marcinko & Associates our clients traditionally include physicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
D.E. Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
***
But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
***
Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
***
CONTACT US TODAY – THRIVE TOMORROW!
Suite #5901 Wilbanks Drive
Norcross, Georgia USA 30092-1141
email: MarcinkoAdvisors@msn.com
***
***
Filed under: "Advisors Only", "Ask-an-Advisor", "Doctors Only", Accounting, Career Development, Estate Planning, Ethics, Experts Invited, Financial Advisor Listings, Financial Planning, Health Economics, Health Law & Policy, Healthcare Finance, Interviews, Investing, LifeStyle, Managed Care, Marketing & Advertising, Media Mentions and PR, mental health, Op-Editorials, Practice Management, Practice Worth, Risk Management, Sponsors, Touring with Marcinko | Tagged: advising, coaching, David Edward Marcinko, david marcinko, Dr. David Edward Marcinko, Dr. Marcinko, Marcinko advisors, Marcinko Associates, psychology | Leave a comment »
BY Dr. DAVID EDWARD MARCINKO MBA CMP™
http://www.MARCINKOASSOCIATES.com
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Healthcare Business and Medical Franchises
The International Franchise Association (IFA) estimates that that about $1 trillion in sales, or 40% of all retail sales, were made through franchised establishment last decade. On the positive side, franchises offer a branded practice concept with management training and access to proprietary methods, marketing and advertising campaigns and a host of support. Moreover, there are franchises available for virtually every healthcare product or service, including: diet, weight loss and fitness; vein care and laser surgery; vitamins, nutriceuticals and pharmaceuticals; plastic and cosmetic surgery; dermatology, tanning and skin care; home healthcare and extended, etc.
CITE: https://www.r2library.com/Resource
Some well know established healthcare and medical franchises are: Doctors Express, Being There Senior Care, Home Care Assistance, Personal Training Institute, Inches-A-Weigh, Remedy Intelligent Staffing, Visiting Angels, Unlimited MedSearch, prnYourHealth and Any Lab Test Now.
On the downside, franchises incur high start-up costs, rules and obligations, payment of franchise percentages and many contractual obligations.
Questions to consider when contemplating this business entity include:
Franchise stability, track record, licensing and costs.
Training, support and proximity of other franchises.
Independence, ownership laws, contracts and dispute resolutions,
Screening methods, market size and potential market share.
Replacement cost and transferability?
For more information on Uniform Franchise Offerings Circulars (UFOCs) contact:
Frandata
1130 Connecticut Avenue, NW
Washington DC 20036
202.659.8640
International Franchise Association7
1350 New York Avenue, NW
Washington, DC 20005
202.628.800
Multi-Level Marketing and In-Office Dispensation
A multi-level marketing (MLM) business delivers products or services through a chain of independent distributors rather than traditional retail business outlets. Existing medical practices not only pursue income ancillary, but it is not unusual for beginning practitioners to plan for and include it in their start-up models and business plans.
The first layer is usually the distributor who must sell products/services and recruit additional members to produce a hierarchical organization with many employees. Each distributor profits from direct sales, and from a varying commission stream down-line. It may be best to investigate before you leap into these situations since some may be fraudulent pyramid schemes that sell no useful product or service, and requires only recruiting others into the scheme. Be sure to obtain a Dunn & Bradstreet or TRW credit
report about any MLM company and inquire about current litigation. Most authorities agree that it take 3-5 years before serious money is made in the MLM business.
Moreover, care must be taken with this model. According to colleague Stephen Barrett MD, writing on the Mirage of Multilevel Marketing: “Many any physicians are selling health-related multi-level products to patients in their offices. The companies most involved have included Amway (now doing business as Quixtar), Body Wise, Nu Skin (Interior Design), Rexall, and Juice Plus+. Doctors are typically recruited with promises that the extra income will replace income lost to managed-care.
Back, in December 1997, the AMA Council on Ethical and Judicial Affairs (CEJA) advised against profiting from the sale of “non- health-related products” to their patients. Although CEJA’s policy statement does
not mention products sold through multilevel marketing, CEJA’s chairman said the statement was triggered by the growing number of physicians who had added an Amway distributorship to their practice.”
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Filed under: "Doctors Only", Career Development, Drugs and Pharma, Ethics, Experts Invited, Health Economics, Health Law & Policy, Healthcare Finance, LifeStyle, Managed Care, Marcinko Associates, Touring with Marcinko | Tagged: AMA, AMA ethics, CEJA, D&B, david marcinko, in office dispensation, Marcinko, Marcinko Associates, medical franchises, MLM, multi level marketing, Stephen Barrett MD | Leave a comment »
By Eric Bricker MD
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Filed under: "Doctors Only", Ethics, Experts Invited, LifeStyle, Managed Care, Op-Editorials, Quality Initiatives, Videos | Tagged: choose doctor, choose physicians, DO, DPM, Eric Bricker, how to choose a doctor, how to choose a physicians?, how to select a doctor, MD, ZocDoc | Leave a comment »
By Staff Reporters
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More than 75,000 workers employed by Kaiser Permanente, one of the largest nonprofit healthcare providers in the US, plan to walk off the job for three days—starting today.
Healthcare workers across the industry are experiencing challenges, which Kaiser acknowledged in response to the looming strike. According to a statement by the company, up to two-thirds of healthcare staff everywhere are burnt out. That’s exacerbated by the issues Kaiser employee unions say they’re striking over, including:
Kaiser insists it pays a decent and denied claims of being short-staffed, saying it hired 22,000 people already this year.
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Physicians, hospitals, and emergency rooms will not be impacted, but some facilities will have reduced staff for nursing and support roles.
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Filed under: "Doctors Only", Accounting, Breaking News, Career Development, Ethics, iMBA, Inc., Managed Care | Tagged: doctors strikes, Kaiser Permanente, Kaiser Permanente Strike, KP, KP strike, medical unions, nurses strike, unions | Leave a comment »
Hospitals are Dropping Medicare Advantage [Part C] Plans – Left and Right
By Dr. David Edward Marcinko MBA
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Hospitals Say Bye-Bye?
Medicare Advantage provides health coverage to more than half of the nation’s seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping the private plans altogether. Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.
“It’s become a game of delay, deny and not pay,” Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker’s. “Providers are going to have to get out of full-risk capitation because it just doesn’t work — we’re the bottom of the food chain, and the food chain is not being fed.” Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end December 31st for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net and a few more smaller carriers.
Source: Becker’s Hospital Review [9/27/23]
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Cigna to Pay $172M Over Alleged Medicare Advantage Fraud
The Cigna Group will pay $172.3 million to resolve allegations that it violated the False Claims Act by submitting incorrect Medicare Advantage patient data to CMS to receive higher payments from the agency. The U.S. Attorney’s Office for the Eastern District of Pennsylvania alleged Sept. 30 that Cigna also falsely certified that the submitted data was accurate, failed to withdraw the “untruthful” data, and did not repay CMS.
Cigna will use $135.3 million from the settlement to resolve the allegations from the Justice Department. The remaining $37 million will resolve allegations related to unsupported diagnoses for Medicare Advantage enrollees that received in-home services from Cigna. As part of the settlement, Cigna has entered into a five-year accountability and auditing agreement with HHS’ Office of Inspector General, which will require company executives and board members to certify Cigna’s compliance moving forward. The payer must also conduct annual risk assessments and submit to independent risk adjustment audits.
Source: Jakob Emerson, Becker’s Payer Issues [10/2/23]
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Filed under: Ethics, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Managed Care, Marcinko Associates, Touring with Marcinko | Tagged: Anthem, Becker's, Blue Shield California, Centene, Cigna, david marcinko, Dr. Marcinko, Marcinko Associates, medicare, Medicare Advantage, Medicare C, Part C, Part C Medicare, UnitedHealthcare | Leave a comment »
By Maia Anderson and Staff Reporters
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Watch out, private practice ownership. According to HealthcareBrew, Dental Support Organizations (DSOs) are the hot new business model for dentistry.
CITE: https://www.r2library.com/Resource
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DSOs are companies that take on all the business-related tasks necessary to run a dental practice, like IT support, accounting and billing, marketing, and facility maintenance, Lisa Ward, VP of communications at industry trade group the Association of Dental Support Organizations, told Healthcare Brew.
A DSO can own the dental practice it operates, or a private practice can contract with a DSO. Some DSOs are owned by a group of dentists, but private equity firms own many large DSOs, according to the Academy of General Dentistry.
The idea behind a DSO is that the “dentist can focus on patient care and not have to worry so much about the business side,” Ward said.
The DSO business model was created in 1975 but didn’t become popular until the 1990s, as dentists graduated with piles of student debt and found it hard to open their own practice, according to Huron Consulting Group.
Today, 10.3% of dentists are affiliated with a DSO, per investment banker Harris Williams. In 2020, 30% of dental school seniors said they planned to join a DSO-affiliated practice, compared to 12% in 2015, a survey from the American Dental Education Association found.
The rise in popularity of DSOs has brought about the decline of private practice ownership. In 2021, the number of dentists who owned their practices fell to 73%, according to research from the ADA.
Maia at anderson@morningbrew.com.
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RELATED: https://medicalexecutivepost.com/2007/11/27/ppmc-redux/
MORE: https://medicalexecutivepost.com/2022/11/30/the-benefits-of-dentistry-unhurried/
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Filed under: "Doctors Only", Drugs and Pharma, Ethics, Experts Invited, Health Economics, Health Insurance, Healthcare Finance, Investing, Managed Care | Tagged: ADA, ADEA, DDS, dental business model, dental marketing, dentistry, dentists, DMD, DPMC, DSO, HealthcareBrew, Huron, Intelligent Dental Marketing, Lisa Ward, Maia A, Maia Anderson, PPMC | Leave a comment »
By Staff Reporters
“Uber Health is foraying deeper into healthcare with a new feature that allows providers to order prescriptions to be dropped off at patients homes same-day. The same-day prescription delivery is meant to help patients adhere to a medication schedule.”
According to Rebecca Pifer of HealthCareDive:
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Filed under: Alternative Investments, Career Development, Drugs and Pharma, Ethics, Health Economics, Health Insurance, Information Technology, LifeStyle, Managed Care | Tagged: drug delivery, Drugs, Medicare Advantage, prescriptions, Rebecca Pifer, Rx, Rx delivery, ScriptDrop, Uber, Uber Health | Leave a comment »
By David Edward Marcinko MBA CMP™
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SPONSOR: http://www.MARCINKOASSOCIATES.com
Merging Medical Practices
There are only three possibilities if you want to go into practice for yourself; buy a practice; franchise a business, or start one. However, if you have an existing practice, merging it to form a larger entity can be a satisfying experience. The pace of practice mergers is accelerating, but it is often difficult to make an informed judgment about synergy. Mergers make sense only if the resulting value is more than additive to the original; not duplicative.
CITE: https://www.r2library.com/Resource
Unfortunately, far too many mergers fail to create, or actually destroy existing value. So, look for complimentary processes, personalities and ideas. In a merger of two existing practices, there is no substitute for personal interaction between employees and physician-management. This creates cross-pollination and new ideas in everything from service-lines and the patient production process, to marketing and finance, and to proprietary and intellectual rights. Most importantly, it allows
diversity of ideas.
And so, the following are questions to consider when contemplating a medical practice
merger:
What are the risks of this transaction and how are they mitigated?
Will talented employees be retained on both sides and can an exodus be
prevented?
Are the specific liabilities of each practice known? Remember, the farther outside
your area of specialty or expertise, the greater the risk of being wrong.
Will I appraise each practice independently, and correctly?
Where will employee allegiance rest?
What is the name, and logo, of the new entity? Who will be the CEO?
Vertical Integration: https://medicalexecutivepost.com/2023/04/14/integration-as-a-competitive-strategy-in-healthcare-reform/
More: https://medicalexecutivepost.com/2022/06/19/healthcare-mergers-acquisitions-2021-in-review/
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Filed under: "Ask-an-Advisor", "Doctors Only", Accounting, Health Economics, Healthcare Finance, Interviews, Managed Care, Marcinko Associates, Touring with Marcinko | Tagged: M&As, medical practice acquisitions, Medical practice M&As, medical practice mergers, medical practice vertical integration, Medical Vertical Integration, vertigal integration | Leave a comment »
By Staff Reporters
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Nearly two dozen pharmacists at the nation’s largest retail pharmacy chain staged a walkout in the Kansas City metro area this week over working conditions they say put CVS Health pharmacists and patients at risk.
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The walkout began Thursday and continued into Friday. Organizers said they had shuttered numerous pharmacies across the metro area, which covers a portion of eastern Kansas and western Missouri. Some pharmacies outside the metro area also have joined. They estimated at least 22 locations had closed.
CITE: https://www.r2library.com/Resource
While the group’s specific complaints focus on store staffing and quotas, the walkout reflects a rising outcry from pharmacists at several national pharmacy chains. They say their work requirements leave them unable to safely fill and verify prescriptions, putting patients at risk of serious harm or even death.
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Filed under: "Doctors Only", Breaking News, Career Development, Drugs and Pharma, Health Economics, Health Insurance, LifeStyle, Managed Care, Op-Editorials, Practice Management | Tagged: CVs, CVS Health, CVS pharmacists walk out, CVS walk out, druggist, pharmacist walk out, pharmacists, pharmacists walk put, RPh | Leave a comment »
WHAT WE DO AND HOW WE ASSIST MEDICAL COLLEAGUES
Hard Business Advice AND Personal Lifestyle Coaching
http://www.MARCINKOASSOCIATES.com
By Ann Miller RN MHA CMP™
At Marcinko & Associates our clients traditionally include physicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
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But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
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Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
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http://www.DavidEdwardMarcinko.com
CONTACT US TODAY – THRIVE TOMORROW!
Suite #5901 Wilbanks Drive
Norcross, Georgia USA 30092-1141
email: MarcinkoAdvisors@msn.com
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Filed under: "Advisors Only", "Ask-an-Advisor", "Doctors Only", Accounting, Career Development, Estate Planning, Ethics, Experts Invited, Financial Advisor Listings, Financial Planning, Health Economics, Health Law & Policy, Healthcare Finance, Interviews, Investing, LifeStyle, Managed Care, Marketing & Advertising, Media Mentions and PR, mental health, Op-Editorials, Practice Management, Practice Worth, Risk Management, Sponsors, Touring with Marcinko | Tagged: advising, coaching, David Edward Marcinko, david marcinko, Dr. David Edward Marcinko, Dr. Marcinko, Marcinko advisors, Marcinko Associates, psychology | Leave a comment »
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